A Combined Approach to Pain Management in the Surgical Neonate

Abstract

Over the past decade, survival rates of preterm and acutely ill infants who have gastrointestinal (GI) anomalies or diagnoses that require surgical treatment in the neonatal intensive care unit (NICU) have improved dramatically. However, despite the technological advances, morbidity rates including neurosensory deficits, cognitive delays, and motor impairments remain high. Because these compromised infants are surviving the diagnoses and concomitant surgery, it behooves caregivers and researchers to identify caregiving practices that can be combined with existing treatment modalities to maximize long-term outcomes for infants and families and minimize the pain associated with the diagnosis, surgery, investigative tests, and ongoing treatment. Recent studies have shown that when infant pain is not recognized and/or left untreated, immediate and long-term consequences ensue. Severe unrelieved pain can cause an overwhelming stress response, which can lead to serious complications including prolonged wound healing, increased need for assisted ventilation, and death. Infants are particularly vulnerable to the undertreatment of pain because they cannot report or describe their pain the way older children and adults can. Theymust rely on their caregivers' ability to interpret their cues of pain, manage it appropriately, and when possible, prevent it. Infants have the necessary neurotransmitters to transmit pain, but they have poorly developed mechanisms by which to inhibit the negative effects. Their inability to modulate the negative effects of pain are affected by gestational age and severity of illness, thereby placing the most vulnerable infants at highest risk for consequences of prolonged pain. Despite ample evidence to support infants' ability to experience pain, the provision of timely and adequate analgesia is fraught with